JP2014519386A - Fiber optic sensing determines real-time changes in applicator placement for interventional therapy - Google Patents

Abstract

  A system for monitoring changes during treatment includes a first probe segment 112 having a fiber optic sensor disposed therein. The first segment is inserted percutaneously in or near the target area to provide a local reference for one or more treatment devices. The second probe segment 114 is disposed within the fiber optic sensor. The second segment is generally located away from the first probe and provides a spatial reference point for the first segment. The first and second segments have at least one common position that serves as a reference between the first probe and the second probe. The shape determination method 107 is configured to determine a shape of each of the first and second segments based on a feedback signal, measure a change in the shape during a procedure, and update a treatment plan with the change. The

Description

  This application claims priority from co-assigned US Provisional Patent Application No. 61/495906, filed June 20, 2011, incorporated herein by reference.

  The present disclosure relates to medical devices and methods, and more particularly to systems and methods for fiber optic sensing that determine applicator placement in real time during interventional therapy.

  Brachytherapy can be used for the treatment of malignant tumors by using ionizing radiation. One important challenge to brachytherapy can be to ensure that the delivery of radiation dose is accurately performed by a pre-treatment plan. This challenge can include, for example, precise placement of brachytherapy sources, deviations from the plan that can result from placement errors, target volume deformations such as tissue swelling, or formation of edema within the surgical cavity. Including the need to compensate for changes in radiation transport properties. Existing methods generally rely on imaging information that can provide a snapshot of applicators and / or seed locations in time. Implanted beacons are used to detect organ movement.

  These approaches can be considered limited in spatial accuracy and / or timeliness of change detection.

  According to the present principles, a system for monitoring changes during therapy includes a first probe segment having a fiber optic sensor disposed therein. The first segment is inserted percutaneously in or near the target area to provide a local reference for one or more treatment devices. The second probe segment has a fiber optic sensor disposed therein. The second segment is generally located away from the first probe and provides a spatial reference point for the first segment. The first and second segments have at least one common position to function as a reference between the first probe and the second probe. A shape determination method is configured to determine a shape of each of the first and second segments based on a feedback signal, measure a change in the shape during a procedure, and update a treatment plan with the change .

  A workstation that monitors changes during treatment includes a computer including a processor and memory. The shape determination module is configured to determine a shape of the plurality of flexible probes based on the feedback signal stored in the memory. The flexible probes each have an optical fiber sensor disposed therein. The flexible probe is configured to measure the change in shape during a procedure to provide a reference position for one or more therapeutic devices. A treatment plan module is stored in the memory and is configured to compare and update treatment plans based on the reference position for the one or more treatment devices. The plurality of probes have at least one common position to function as a reference between the probes. The probe is disposed first or percutaneously in or near a target region and generally spaced away from the first probe and provides a spatial reference point for the first probe. 2 probes.

  A method of monitoring changes during treatment inserts at least one flexible probe into the body percutaneously to a location within or near the targeted tissue region for focal energy deposition. Determining the position and path activation of the source for the focus energy application, wherein the probe has at least one fiber optic sensor, and quantifies the deviation from the treatment plan Comparing the real-time location and path activation with the treatment plan, and providing treatment indications to achieve a treatment goal taking into account the deviation in activities after the treatment.

  These and other objects, features and advantages of the present disclosure will become apparent from the following detailed description of specific embodiments read in conjunction with the accompanying drawings.

  The present disclosure presents in detail the following description of preferred embodiments with reference to the following figures.

FIG. 2 is a block / flow diagram illustrating a system and / or workstation for performing adaptive therapy according to the present principles. 1 is a cross-sectional view of a probe illustrating an optical fiber sensor configured according to one specific embodiment. It is a figure which shows the notional structure which uses the some optical fiber sensor by one Example. FIG. 6 is a flow diagram illustrating steps for performing treatment and making real-time adjustments according to a specific embodiment.

  In accordance with the present principles, systems and methods are provided for determining, estimating and / or visualizing (in real time, during treatment) the position and path trajectory of a source for focus energy application. Focus energization can be applied, for example, to a radiation source for brachytherapy or other treatments, cryotherapy probes, laser ablation, photodynamic therapy, high intensity focused ultrasound therapy, or other types of minimally invasive local ablation. Etc. may be included. The systems and methods are used to associate these real-time decisions and / or estimates with treatment plans and intra-treatment imaging or other biophysical monitoring to quantify potential deviations from the plan. The This results in triggering and guiding the proper adaptation of the treatment to achieve the treatment goal despite deviation from the original treatment plan.

  In one embodiment, the collection of (exactly) known source locations within the tissue anatomy of interest is based on the known characteristics of source-tissue interactions and so on to calculate the final spatial distribution of dose delivery. Can be combined. For example, this information can be associated with patient-specific clinical results, which can be, for example, future optimization of such procedures, trained physicians, clinical outcome studies, and / or seed placement patient-specific. Can be used to create libraries / databases / atlases for atlas / database driven automation. The principles include estimating deviations from the planned delivery position in real time throughout the placement of the brachytherapy source and overcome a wide range of problems and / or disadvantages for proper compensation Can be used. Furthermore, exemplary systems and methods apply to other minimal or non-invasive treatment modalities that use focus energy application such as cryotherapy, RF ablation, laser ablation, photodynamic therapy, high intensity focused ultrasound, etc. It can also be possible.

This principle is generally described for interventional procedures. The interventional procedure can take many forms. A few non-limiting examples are described here for illustrative purposes. In one example, brachytherapy can be used for the treatment of malignant tumors using ionizing radiation. It is generally considered that there are two main forms of brachytherapy. These include permanent seed implantation and high dose rate brachytherapy. Permanent seed implantation, which can also be referred to as low-dose rate brachytherapy, uses rice grain-sized metal seeds containing radioactive isotopes such as ¹²⁵ I or ¹⁰³ Pd. The isotope is permanently inserted into the treatment volume through a needle or catheter. Typically, the needle or catheter is inserted sequentially along different trajectories, and the seed is fed into the target tissue at a location along the needle or catheter insertion track while the needle or catheter is retracted. The The radiation dose can be delivered over a period of weeks to months. High dose rate brachytherapy can be inserted to a specified location at a specified time with a radioisotope or miniature X-ray source inserted, for example, to deliver several sessions of internal radiation therapy over a two day course. Possible ("afterloading") including multiple catheter arrangements. After the course of treatment, the catheter can be removed. The catheter can form a line such as a parallel bundle or meridian along the surface of the balloon applicator.

  For both types of brachytherapy, an accurate dose of radiation to the tumor is required and the dose received by adjacent tissue should be minimized. Plans using pre-treatment images are often used to adjust the dose distribution for the patient's anatomy. Computed tomography (CT), magnetic resonance (MR) or ultrasound (US) images can be used to provide a relatively high contrast for many tumor types.

  For brachytherapy, compensation for changes in radiation transport properties such as placement errors, catheter movement, target volume deformations such as tissue swelling, or edema formation within the surgical cavity needs to be taken into account. is there. For example, if a large shift in source position, target tissue placement, or target volume content occurs, the plan performed using the pre-treatment image is probably no longer relevant, and as a result, the tumor is insufficient It may be treated and adjacent tissue may be at risk for radiation damage.

  According to a preferred embodiment, optical shape sensing is used to assist in tracking components for patient treatment. In a particularly useful embodiment, a three-dimensional (3D) shape of a flexible elongated structure can be tracked in real time. For example, the basic principles underlying optical shape sensing implemented using Fiber Bragg Grating (FBG) and Rayleigh scattering are trusted to provide detailed spatial information for the tool during the procedure. For optical shape sensing, the 3D position of a patient's specific location can be tracked. This sensing method may also allow, for example, tracking the 3D shape of a deformable mesh that can be tightly fitted around the patient's body.

  For other tracking methods, such as electromagnetic (EM) tracking, optical shape sensing is for EM field distortion that can be caused by the presence of external magnetic fields and metal objects (eg, a common occurrence in clinical practice). Can have the advantage of tolerance.

  While the present invention will be described with respect to medical devices, however, the teachings of the present invention are much broader and are applicable to devices used in tracking or analyzing complex biological or mechanical systems. I want you to understand. In particular, the present principles are applicable to treatments in all areas of the body such as internal follow-up procedures of biological systems, lungs, gastrointestinal tracts, evacuators, blood vessels and the like. The elements depicted in the figures can be implemented in various combinations of hardware and software, and can provide functionality that can be combined in a single element or multiple elements.

  The functions of the various elements shown in the figures can be provided by the use of hardware capable of executing software in conjunction with the depicted hardware and appropriate software. When provided by a processor, the functionality can be provided by a single dedicated processor, by a single shared processor, or by multiple individual processors that can be partially shared. Furthermore, the explicit use of the word “processor” or “controller” should not be construed to indicate exclusively hardware capable of executing software, and without limitation, a digital signal processor (“DSP”). Hardware, read only memory ("ROM") for storing software, random access memory ("RAM"), non-volatile storage media, etc. can be implicitly included.

  Moreover, all presentations described herein of principles, aspects and embodiments of the invention and specific examples are intended to include both structural and functional equivalents. In addition, it is intended that such equivalents include both presently known equivalents and equivalents developed in the future (ie, developed elements that perform the same function regardless of structure). Thus, for example, those skilled in the art will appreciate that the block diagrams shown herein represent conceptual diagrams of illustrative system components and / or circuits that implement the principles of the invention. Similarly, flowcharts and / or flow diagrams represent various processes that may be substantially represented in a computer-readable storage medium and that may be executed by a computer or processor, in which case such computers or processors are Not shown.

  Further, embodiments of the invention may take the form of a computer program accessible by a computer-usable or computer-readable storage medium that provides program code for use by or associated with a computer or instruction execution system. For purposes of this description, a computer-usable or computer-readable storage medium may store, communicate, propagate, or transport a program used or associated with the instruction execution system, apparatus, or device. It can be a device that can. The medium can be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or apparatus or device), or a propagation medium. Examples of computer readable media include semiconductor or solid state memory, magnetic tape, removable computer diskettes, random access memory (RAM), read only memory (ROM), hard magnetic disks and optical disks. Current examples of optical disks include compact disk-read only memory (CD-ROM), compact disk-read / write (CD-R / W), DVD and Blu-ray.

  Referring now to the drawings in which like numerals represent the same or similar elements, first referring to FIG. 1, a system 100 for focal energy application for minimal or non-invasive local tissue ablation is illustrated by one specific example. System 100 is part of a treatment planning and monitoring workstation that links shape sensing information, source-tissue interaction modeling, dose monitoring, and patient-specific clinical outcome databases for treatment optimization, reporting and physician training. It can be. The system 100 may include an image database or memory storage unit 104. The database 104 stores an image, preferably a three-dimensional (3D) image of the patient 122 on which the procedure is to be performed. System 100 includes a computer 106 having a processor 105 that can execute a shape sensing determination algorithm or method 107 stored in memory 109.

  The optical console 108 is controlled by the computer 106 and provides data. The optical console 108 supplies light to the fiber optic probes 112 and 114 and receives light from the probes 112 and 114. Probes 112 and 114 are flexible and each include a fiber optic shape sensor. Note that the number of probes may be greater than 2 or a single probe may be used. The first probe 112 and the second probe 114 may include two segments on separate tethers, or may include different subsections or segments on the same tether. It should also be understood that each probe 112, 114 may include a plurality of optical fibers, such as 2, 3, 4 or more fibers. Fiber optic shape sensing can take many forms and may use different techniques such as multi-core geometry, interferometer, polarization diversity, laser characteristics, and the like. Shape sensing is described by way of example in published patent application US2011 / 0109898 to Froggatt et al., Incorporated herein by reference.

  With continued reference to FIG. 1, and with reference to FIG. The sensor 202 includes four fibers with a single mode core 206 constrained within an elongated body with a circular cross section. Light from the optical console 108 can be directed to each fiber either simultaneously or sequentially. In each fiber 202, light is reflected at different distances, either FBG or Rayleigh scattering, depending on how the optical fiber 202 is configured. Preferably, the optical fiber 202 is arranged substantially helically along the length of the sensor. This is one typical design. Other typical designs or techniques according to the present principles may be used.

  Referring back to FIG. 1, the computer 106 includes a memory 109 that stores a shape determination algorithm or method 107 that determines the shape and position of the flexible probes 112 and 114 based on measurements obtained from the optical console 108. be able to. In one exemplary embodiment, at least one of the probes 112 is inserted into the body of the patient 122 percutaneously to a location in or very close to the targeted tissue region 118 by focus energy application. Can do. The feedback loop is based on the output or update of the shape determination algorithm 107 (by the treatment system 136 and / or the planning module 116) so that the targeted tissue region 118 and treatment intensity is, for example, due to movement, swelling, edema, etc. It can be provided between the shape determination algorithm 107 and the treatment system 136 or the planning module 116 so that it can be modified.

  Preferably, there is a single probe or a plurality of one or more reference points along such a probe that can characterize the localization / orientation of the patient anatomy near the treatment volume (118) To do. The location of the first flexible probe 112 can thus be tracked relative to the location of the reference point (eg, by the probe 114). If the second flexible probe 114 is used as a reference, the second flexible probe 114 ensures that the error in the output of the shape determination algorithm 107 is as similar for both probes as possible. As such, it can be mechanically attached or coupled to the first flexible probe 112 at the proximal end. The mechanical attachment between the two probes is characterized when the attachment point and the associated tracking error at that point tracks the second probe 114 and, if considered, a segment along the probe 112 It can also be realized using the coupling of the second probe 114 to the first probe 112 in an intermediate position. Coupling of probes 112 and 114 can be provided using a sheath 110 or other device to join the proximal ends of probes 112 and 114 together. If the segments (probes) are on the same tether (inline), the common reference point is a shared connection point between the two segments.

  Additional markers (eg, multiple sheaths with EM markers 117) on the probes 112, 114 at one or more reference positions along the length of the probes 112, 114 that can be tracked by methods other than optical shape sensing. 110 or connection point). Information from these markers 117 can be incorporated into the shape determination algorithm 107 in real time to improve the accuracy of the shape determination algorithm 107. These exemplary markers 117 may not provide information about the spatial position of the probe tip itself, but are more of the probes 112, 114 that can still present boundary conditions that are useful to the shape determination algorithm 107. Information regarding the spatial location of the proximal portion can be provided.

  In one example, the patient 122 can be placed on a platform 124 that can be translated using the motion controller 102. Tumor region 118 is the intended radiation therapy target. The system 100 can include a device 113 that provides radiation, and the device 113 can include a needle, catheter, or other device 113 for implanting a seed or focusing the radiation within a tumor 118. Device 113 is connected to probe 112 such that the location and placement trajectory of the treatment device (eg, radiation seed) is known using fiber optic sensing feedback from probe 112. Other radiation delivery or treatment systems 136 can also be used. One flexible probe 112 (including a fiber optic sensor) extends from the optical console 108, joins to the therapeutic application catheter (N) 113, and follows the catheter 113 to the tumor region 118.

  A second flexible probe 114, including other fiber optic sensors, extends from the optical console 108 to a fixed region or surface point (SP) on the surface of the patient 122. In this example, near the optical console 108, the two fiber optic sensors of the probes 112 and 114 are sheaths designed to allow minimal twisting with as large a bend radius as possible without loss of function. 110. Within the sheath 110, when the two fiber optic sensors are kept at a fixed angle relative to each other or move freely relative to each other, the position and orientation of the fibers are tracked or relative to each other. And is determined in other ways relative to a common reference in the laboratory or environmental coordinate system. The optical console 108 can be parallel in time-defined (or time-stamped) high-speed interleaved format, either sequentially or with simultaneous readout from both fiber sensors (depending on the configuration of the interrogation platform). Either interrogate or poll the measurements from each of the two fiber sensors. This concept can be further extended to more than two fibers to allow guidance to multiple treatment sites in parallel.

  Data from the optical console 108 can be received by a computer 106 that processes the data with a shape determination algorithm 107. In this way, the computer 106 obtains an estimate of the 3D shape of the optical fiber within the probes 112 and 114. The shape determination algorithm 107 may include as a boundary condition the fact that the two fiber optic sensors have a known position / orientation relative to each other within the sheath 110 or are mechanically constrained. The relative position / orientation of the two fiber sensor reference positions can be alternately obtained from the actual measurement of the reference marker and external tracking using a secondary position / orientation measurement device (eg 117).

  After obtaining these decisions and / or estimates, the computer 106 compares them with previous time points decisions, treatment plans and / or estimates, and the body of the patient 122 referenced by the second flexible probe 114. It can be determined whether applicator movement has occurred.

  In one embodiment, the treatment planning module / system 116 may have a portion stored in the memory 109 or stored in the memory 109. The treatment planning module / system 116 is configured to determine the planned placement of the one or more treatment devices (eg, seeds, catheters, etc.) based on the path trajectory determined from the probe 112. It can be configured to compare with the actual arrangement. The treatment planning module 116 is configured to output a later position for the placement of the one or more treatment devices based on achieving an overall planning goal. The treatment plan module 116 weights with an alternative roadmap and / or clinical decision tree based on previous history so that an evaluation of current feedback can be used to ensure that the goals of the treatment plan are met. System can be included.

  If there is no relative movement between the actual measurement and the treatment plan, the 3D shape of the part of the sensor (probes 112 and 114) fixed to the patient 122 moves in synchrony (ie together). Can be expected to do. Otherwise, they have asynchronous movements that indicate changes. The impact of the detected relative motion is in this case the same previous survey in a database or library that links the patient's anatomy information and interventional path characteristics obtained using the pre-treatment image database 104 with clinical results. Determined using the information obtained from. If the relative movement exceeds a defined alarm limit, a warning is given and treatment is stopped until adaptation of the treatment plan with a modified applicator arrangement. The alert may be generated audibly, visually on display 119 or by other suitable methods including tactile feedback within the probe itself.

  Programming, device control, functional monitoring, and / or other interactions with the computer 106 or workstation 101 may be performed using the interface 128. Display 119 may also allow a user to interact with workstation 101 and its components and functions, or other elements within system 100. This is further facilitated by an interface 128 that includes a keyboard, mouse, joystick, haptic device, or other peripheral device or controller to allow interaction with the workstation 101 or system 100 and user feedback.

  In another exemplary embodiment, a flexible probe 112 with the fiber optic sensor can be inserted to reach the tumor region using intravascular access. For example, the probe 112 can be advanced through the patient's vasculature until it is close to the tumor region 118. The probe 112 is in this case inserted through the vessel wall towards the tumor region 118. This exemplary procedure could possibly be performed with a fluoroscopic guide using, for example, the imaging system 130 in combination with a radio-opaque contrast agent. Other imaging techniques can also be used. More than one flexible probe (112) can be inserted into the tumor region 118. More than one flexible probe (114) may also be placed at additional points outside the tumor region 118 to monitor the position of the patient 122 or other equipment used during the procedure.

  In one specific example, the flexible probe 134 (eg, a treatment applicator or other device) can be tracked and / or imaged independently of the optical console 108. For example, the data from these tracking / imaging methods may, for example, improve the accuracy of 3D shape estimation and / or delineate physiological structures (both target and normal tissue) within the volume of interest (118). It can be used by the shape determination algorithm / procedure 107 to impose additional geometric constraints on the spatial location of the probes 112, 114. In this way, independent reference points are created using tracking techniques such as EM, imaging (imaging system 130), etc., and confirmation regarding the position / orientation of other probes 112, 114 used in the procedure. Enable. The imaging device 130 and the treatment system 136 can be connected to the workstation 101. In this way, the imaging system 130 and the treatment system 136 can be controlled and / or provide feedback by the rest of the system 100.

  In other embodiments, a greater number of flexible probes with fiber optic shape sensors can be used to monitor flexible surfaces and / or volumes. These surfaces or volumes may or may not be the target of interest, such as a tumor, but may instead include patient movement, movement of internal organs, movement of a platform 124 or other platform, movement of instruments, etc. Good. The region is one or more optical fibers that can be used to obtain an estimate of 2D or 3D changes in the applicator and / or tissue geometry that can occur inside and / or outside the tumor region 118. A shape sensor may be included. Such an embodiment can be more complex, possibly using more than two fiber optic shape sensors (probes 112 or 114). This may possibly provide more information regarding the movement of the treatment applicator relative to the target and / or normal tissue, for example. The system 100 can be modularized to easily accommodate multiple flexible probes with fiber optic sensors.

  Referring to FIG. 3, the figure shows an illustrative conceptual embodiment in accordance with the present principles. The movable mass 302 includes a flexible material target 304. Both the mass 302 and the target 304 can vibrate or change position in three dimensions. The mass 302 and the target 304 can move a limited amount relative to each other, but can also move together. In order to consider the dynamic nature of both mass 302 and target 304, it is necessary to understand the relative and global movement of both. According to the present principles, fiber optic sensors 306, 308 are used to locally monitor changes in the position / orientation of mass 302 and target 304. The fiber optic sensor 308 can detect local distortion with respect to the local coordinate system 312 with high resolution. Accordingly, the fiber optic sensor 308 is positioned at or near the target 304 to detect local strains.

  Similarly, local distortion (eg, position / movement) of mass 302 needs to be monitored relative to local coordinate system 310. In this case, the fiber optic sensor 306 may be placed on the mass 302 to monitor local changes. In addition, the location of the target 304, mass 302, and device 309 (eg, radiation source, seed, etc.) needs to be understood by a more global coordinate system 314. The device 309 is placed by a tracking tool, so these positions are known accurately. Additional information relating the coordinate systems 310 and 312 can be provided by various constraints and boundary conditions. For example, fiber optic sensors 306 and 308 can share a common location, or are tracked in other ways so that a reference point on one fiber is known relative to a reference point on another fiber. The As described above, this can be accomplished by bundling a portion of the optical fiber to both sensors 306 and 308 (eg, in a sheath or the like). In this way, common criteria or constraints are known and solutions for all other points along the fiber optic sensors 306 and 308 can be determined and monitored relative to the common coordinate system 314.

  As described above for radiation therapy, monitoring of target 304 may include changes due to target area swelling, patient activity, equipment movement, placement errors of device 309, and the like. Having other reference points from the sensor 306 can indicate the orientation of the mass 302 (eg, patient on a platform or platform) relative to other sensors 308 as well as local movement relative to other locations on the patient. Also provide information. In this example, this may provide a guide to radiation aiming / focusing, radiation seed placement, and the like.

  Referring to FIG. 4, a method for monitoring changes during treatment is illustratively shown. At block 402, the position and path trajectory of the source for focal energy application percutaneously passes at least one flexible probe into the body to a location within or near the region of tissue targeted for the focal energy application. Determined by insertion. The probe includes at least one fiber optic sensor. In one embodiment, the probe may be included with the device (eg, a needle) that positions the source such that the source position and path trajectory are easily identified.

  At block 404, a feedback signal is collected from the at least one flexible probe and input to the shape determination module to detect a change in the at least one flexible probe, thereby depending on a treatment plan, The region of tissue targeted for treatment and the intensity of treatment can be changed based on the output of the shape determination module.

  At block 406, the location and path trajectory are compared in real time with a treatment plan to quantify deviations from the plan. At block 408, a second probe can be introduced to provide a reference position for the first probe. The second probe also preferably includes at least one fiber optic sensor. The at least one flexible probe and the second probe can share at least one common location to provide a constraint or condition that associates a coordinate system at block 410, or each probe can be It is possible to have a reference position that is already known.

  At block 412, treatment indications are provided to achieve a treatment goal based on the collected feedback and plan comparison. The deviation is taken into account in later activities within the procedure. At block 414, a later position for the placement of the one or more treatment devices based on achieving an overall planning goal may be output. Other changes, suggestions or actions may be required to ensure that the treatment plan goals are achieved. In block 416, an additional tracking device configured to independently track the path of the at least one flexible probe confirms and / or improves the position measurement of the at least one flexible probe or sensor It can be used to provide other forms of solution constraints or conditions that determine position information for the probe. In block 418, the procedure is continued until it is completed, for example, until the planned goal is achieved.

In interpreting the appended claims, it should be understood that:
a) The word “comprising” does not exclude the presence of elements or acts other than those listed in a given claim.
b) The word “one” preceding an element does not exclude the presence of a plurality of such elements.
c) Reference signs in the claims do not limit their scope.
d) Multiple “means” may be represented by the same item or hardware or software implementation structure or function.
e) The specific order of operations is not intended to be required unless otherwise indicated.

  Modifications and variations are described, describing preferred embodiments for systems and methods for fiber optic sensing to determine real-time changes in applicator placement for interventional treatments (which are intended to be illustrative and not limiting) Note that can be made by those skilled in the art in view of the above teachings. Accordingly, it is to be understood that variations that are within the scope of the disclosed embodiments outlined by the appended claims can be made in the specific embodiments of the disclosed disclosure. What is described in detail herein, and what is required by patent law, is claimed and desired to be protected by Letters Patent, is set forth in the appended claims.

Claims (23)

In a system that monitors changes during treatment,
A first probe segment disposed within the fiber optic sensor and percutaneously inserted in or near the target region to provide a local reference for one or more treatment devices;
A second probe segment disposed in a fiber optic sensor, generally disposed away from the first probe, and providing a spatial reference point for the first segment, the first and second The second probe segment having at least one common position such that the segment serves as a reference between the first probe and the second probe;
A shape determining module that determines a shape of each of the first and second segments based on a feedback signal, measures a change in the shape during a procedure, and updates a treatment plan with the change;
Having a system.   The shape determination module receives an optical signal, determines a path trajectory of the first segment, and an arrangement of the one or more treatment devices is determined based on the path trajectory. System.   The system of claim 2, wherein the one or more treatment devices include a medical instrument having a radiation source.   The system of claim 2, wherein the one or more treatment devices include a radiation seed, and the path trajectory is used to determine a seed position.   The system of claim 2, wherein the one or more treatment devices include a focus treatment radiation source.   The planned placement of the one or more treatment devices is compared with an actual placement of the one or more treatment devices based on the path trajectory to achieve the overall planning goal based on the 1 The system of claim 1, comprising a treatment planning module that outputs a later position relative to an arrangement of one or more treatment devices.   An additional tracking device that independently tracks the path of the at least one of the first segment and the second segment to confirm the position of at least one of the first segment and the second segment; The system of claim 1.   The system of claim 1, wherein the at least one common location includes a tracking device that tracks the location of the at least one common location.   The system of claim 1, wherein the first and second segments include two separate tethers or different subsections of the same tether. In a workstation that monitors changes during treatment, the workstation includes:
A computer including a processor and memory;
A shape determination module stored in the memory and determining a shape of a plurality of flexible probes based on a feedback signal, each of the flexible probes having a fiber optic sensor disposed therein, The shape determination module, wherein a flexible probe measures a change in the shape during a procedure to provide a reference position for placement of one or more treatment devices;
A treatment plan module, stored in the memory, for comparing and updating treatment plans based on the reference position for the one or more treatment devices;
Have
The plurality of probes have at least one common position that serves as a reference between the probes;
A first probe that is inserted percutaneously in or near a target region, and a second probe that is generally disposed away from the first probe and that provides a spatial reference point for the first probe;
including,
Work station.   11. The shape determination module receives an optical signal and determines a path trajectory of the first probe, and the placement of the one or more treatment devices is determined based on the path trajectory. Workstation.   The workstation of claim 10, wherein the one or more treatment devices include a medical instrument having a radiation source.   The workstation of claim 10, wherein the one or more treatment devices include a radiation seed, and the path trajectory is used to determine a seed position.   The workstation of claim 10, wherein the one or more treatment devices include a focus treatment radiation source.   The treatment planning module compares the planned placement of the one or more treatment devices with an actual placement of the one or more treatment devices based on the path trajectory to achieve an overall planning goal. The workstation of claim 10, wherein the workstation outputs a later position relative to an arrangement of the one or more treatment devices.   An additional tracking device for independently tracking the path of the at least one of the first probe and the second probe to confirm the position of at least one of the first probe and the second probe; The workstation according to claim 10.   The workstation of claim 10, wherein the at least one common location includes a tracking device that tracks the location of the at least one common location. In a method of monitoring changes during treatment,
The focus energy application by percutaneously introducing at least one flexible probe comprising at least one fiber optic sensor into the body to a location within or close to the region of tissue targeted for focus energy application. Determining the position and path trajectory of the source with respect to
Comparing the treatment plan with the position and path trajectory in real time, quantifying the deviation from the plan, and the comparing step;
Providing a therapeutic fit to achieve a therapeutic goal in view of the deviation in subsequent activities within the procedure;
Having a method.   Collecting a feedback signal from the at least one flexible probe; and inputting the feedback signal to a shape determination module to detect a change in the at least one flexible probe, the treatment The method of claim 18, further comprising the step of inputting, wherein a plan changes the region of tissue targeted for treatment and the intensity of treatment based on the output of the shape determination module.   The method of claim 18, comprising introducing a second probe that includes at least one fiber optic sensor and provides a reference position for the first probe.   21. The method of claim 20, wherein the at least one flexible probe and the second probe share at least one common location.   19. The method of claim 18, wherein comparing the position and path trajectory includes outputting a later position for the placement of the one or more treatment devices based on achieving an overall planned goal. .   The method of claim 18, comprising using an additional tracking device that independently tracks a path of the at least one flexible probe to verify the position of the at least one flexible probe.

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